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/,1+'PLICATION FOR <br />the ro(B.B <br />CITYOF - CONSTRUCTION e <br />CITY <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259.8745 <br />EVERETT, WA9B201 ®COMBINATION ❑ BUILDING ❑MECHANICAL ❑PLUMBING PERMIT NO. <br />OWNER MAIL ADDNI SS CITY ZIP PHONE <br />�Ac*, Jxk"" �, li0 W. U.5T,6LD&, ga201 25`i -SSi3 <br />ARCHITECT OR DESIGNER MAIL ADDRI SS CITY ZIP PHONE <br />I <br />GENERAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />MECHANICAL CONTRACTOR MAIL ADDRESS CITY ZIP PHONE LICENSE <br />PIVA101NC.CONTRACTOR MAIL ADDRESS CITY ZIP PHCNE LICENSEE <br />Cl US Of WORK IIq� <br />❑NEW ❑ADDITION XALTERATION ❑REPAIR []DEMOLITION ❑FENCE 1:15,GN ❑GARAGE ❑BUILDING RELOCATION <br />VALUATION OF WORK Ol'J <br />DI It RULE I%ORK <br />-2 P, F , o (-Iti Devzr-Ar SG i4o0c.F -m bUPi-cX 14PAert- % <br />rROPOSID USI DI BUILDING�V <br />9t) 0LEX A ---M- 5 <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP- <br />PLICATION /,ND KNOW THE SAME TO BE TRUE AND CORRECT ALL <br />PROVISION', OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />OF WORK WI! L BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br />ANY OTHER STATE OR LOCAL LAW RFAULATING CONSTRUCTION <br />OR THE PERFORMANCE OF CONS ION. <br />SIGNATURE OF CONTRACTOR UTH I NT DATE <br />%�(/(Tie 7 <br />IIGSL Of SCR IPDON Of TROPE RTV (SHOWN BELOW OR ATTACH FOUR COPIES( <br />:AST %2 OF tA1N L <br />0M el 10 BLOCK 2�OF <br />ION A,)ORl <br />2 k z to SS <br />MLOct I.1 ST EMIT <br />PLUMBING <br />MEC ANICAL <br />NO. <br />TYPE OF FIXTURE <br />FEE <br />TIPE OF EQUIPMENT <br />FEE <br />WATER CLOSET I TOLIET) <br />AIR COND UNITS -HP EA <br />BATHTUB <br />'y <br />RL FRIGERATION UNITS-H P EA <br />I. AVATORY EWASH BASIN) <br />00 <br />13CHURS-HP EA <br />SHOWER <br />GAS FIRED AC UNITS -TONNAGE EA <br />KITCHEN SINK A DIST <br />60 <br />FORCED AIR SYSTEM$-B T U. M EA <br />I <br />DISWASHER <br />LAUNDRY TRAP <br />2 <br />CID <br />�� <br />WALL HEATERS - BTU M <br />UNIT HEATERS -BTU M <br />CLOTHES RASHER <br />_ <br />EVAPORATIVE COOLERS <br />WATER HEATER <br />CLOTHES DRYERS <br />URINAL <br />1jI' <br />VEN iION FAN <br />tdD <br />DRINKING FOUNTAIN <br />RANGELATIHOOD <br />FLOOR DRAIN <br />AIR HANDLING UNIT- C F M. <br />- <br />VACUUM BREAKERS <br />STOVE <br />ROOF DRAINS - R.MNLEADLRS <br />AIf TAI. FIREPLACE 8 CHIMNEY <br />SINK ISERVICE -IIAR, ETC) <br />SUB TOTAL <br />SUB TOTAL S <br />PERMIT <br />S <br />PERMIT f <br />TOTAL FEE <br />SI <br />TOTAL FEE S <br />Z <br />G <br />SIDE YARD SETBACK <br />STRIFT SETBACK <br />REAR YARD SETBACK <br />PLAN CHECK NUMBER <br />PLAN <br />FEE (., 3 <br />CHECK FEE <br />RECEIPT IN0. <br />USE ZO'NLE <br />K-Z <br />TOF <br />LOT A EA C� .T- <br />��17 F\. <br />VACANT SITE <br />❑YES 1*0 <br />FEES <br />VALUATION <br />if <br />TYPE CONS IT, <br />-�11E/— I0 <br />OCCUPANCY GROUP <br />P <br />NO OF DWELLING UNITS <br />BUILDING <br />SLeC,L✓� <br />�1 <br />SIZE Of BLDG <br />NO Of STORIES <br />2 <br />MAX OCC LOAD <br />PLUMBING <br />l <br />- <br />V <br />FIRE ZONE <br />IIASEMENT <br />�/5 <br />BHWOOMS <br />FIRE SPRINKLERS <br />REQUIRE <br />nYEs O <br />MECHANICAL <br />iD <br />.7 <br />APPROVALS <br />BY <br />DATE <br />OTHER <br />1 ENVIRONMENTAL CHECK LIST <br />PINALTY <br />UBC <br />SEC JOJ(a) <br />2 BUILDING PLANS <br />TOTAL <br />J FIRE HYDRANT <br />A FIRE PROTECTION SYSTEM <br />PERMIT VALIDATION <br />WHEN PROPERLY VALIDATED (IN THIS SPACE)THIS IS YOUR PERMIT <br />,T 7.�GJ� ((. V'"4 S- X/` . <br />\1 <br />' r(PPL-Le-- - EDE <br />5 GRADINGIE XCAVATION A TEE ARINGIGRUHILING <br />6 DRAINAGE- <br />7 ENVIRONMENTAL IMPACT STATEMENT— <br />B HEALTH DISTRICT <br />APPLICATION ACC BY <br />PLANS CHECKED BY <br />E <br />APPR FOR ISSUANCE BY <br />91 79 <br />7 <br />i <br />